Nursing Elites

1. A female client with depression attends group and states that she sometimes misses her medication appointments because she feels very anxious about riding the bus. Which statement is the nurse's best response?

• A. Can your case manager take you to your appointments?
• B. Take your medication for anxiety before you ride the bus.
• C. Let's talk about what happens when you feel very anxious.
• D. What are some ways that you can cope with your anxiety?

Correct answer: D

Rationale: The best response is to explore ways for the client to cope with anxiety (D). The nurse should encourage problem-solving rather than dependence on the case manager (A) for transportation. While taking medication for anxiety before riding the bus may be helpful, addressing coping strategies should come first (B). Although discussing the feelings of anxiety can be therapeutic (C), the most appropriate approach is to engage the client in finding ways to manage her anxiety effectively.

2. A female client with depression attends a group and states that she sometimes misses her medication appointments because she feels very anxious about riding the bus. Which statement is the nurse's best response?

• A. Can your case manager take you to your appointments?
• B. Take your medication for anxiety before you ride the bus.
• C. Let's talk about what happens when you feel very anxious.
• D. What are some ways that you can cope with your anxiety?

Correct answer: D

Rationale: Encouraging the client to discuss coping mechanisms for anxiety is a supportive approach that empowers the client to manage their symptoms. Choice A may not address the client's self-management and coping skills. Choice B suggests using anxiety medication before riding the bus, which may not be the most appropriate solution. Choice C acknowledges the anxiety but does not actively involve the client in finding solutions, unlike Choice D which promotes client empowerment and self-efficacy.

3. When planning care for a client with anorexia nervosa, which goal should be prioritized?

• A. The client will establish normal eating patterns.
• B. The client will verbalize feelings about food and weight.
• C. The client will gain a minimum of 2 pounds per week.
• D. The client will achieve normal electrolyte balance.

Correct answer: D

Rationale: The correct answer is D because achieving normal electrolyte balance is critical in clients with anorexia nervosa. Electrolyte imbalances can lead to serious, life-threatening complications such as cardiac arrhythmias and organ failure. While establishing normal eating patterns (choice A) and verbalizing feelings about food and weight (choice B) are important aspects of treatment, addressing electrolyte balance takes precedence due to the immediate risks associated with imbalances. Additionally, setting a weight gain goal of 2 pounds per week (choice C) may not be appropriate initially as rapid refeeding can also lead to electrolyte imbalances and other complications.

4. A client is responding to auditory hallucinations and shakes a fist at a nurse and says, 'Back off, witch!' The nurse follows the client into the day room. What action should the nurse implement?

• A. Sit down in a chair near the client.
• B. Position self within an arm's length of the client.
• C. Ensure that there is physical space between the nurse and client.
• D. Move to a position that allows the client to be closest to the room's door.

Correct answer: C

Rationale: In situations where a client is responding to auditory hallucinations and displaying aggressive behavior, it is crucial for the nurse to ensure physical space between themselves and the client. This action can help de-escalate the situation and prevent any potential harm to both the nurse and the client. Sitting down near the client (Choice A) may escalate the situation by invading the client's personal space. Positioning oneself within an arm's length of the client (Choice B) may increase the risk of physical confrontation. Moving closer to the room's door (Choice D) may not be appropriate as it can block the client's exit route and escalate the situation further. Therefore, ensuring physical space between the nurse and the client (Choice C) is the most appropriate action to promote safety and prevent escalation.

5. A young adult female client is admitted to a psychiatric facility with a medical diagnosis of bulimia nervosa. Which nursing intervention has the highest priority?

• A. Schedule the client for group therapy with other clients with bulimia nervosa.
• B. Assign the client's care to a nurse with relevant experience in eating disorders.
• C. Monitor the client carefully for binging and purging activities.
• D. Assess and report the client's electrolyte status to the healthcare provider.

Correct answer: D

Rationale: The correct answer is D. Assessing and reporting the client's electrolyte status to the healthcare provider is the highest priority in a client with bulimia nervosa. Electrolyte imbalances, such as hypokalemia and metabolic alkalosis, are common due to purging behaviors associated with bulimia. Monitoring electrolyte levels is crucial to prevent life-threatening complications. Choices A, B, and C are incorrect because while therapy and monitoring for binging activities are important, addressing the electrolyte imbalances caused by purging behaviors takes precedence in the immediate care of a client with bulimia nervosa.

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